Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review.
Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review.
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基于系统评价的肺部病变活检方法的临床更新。
DOI：
10.1186/s12890-018-0713-6
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发表时间：
2018-09-03
影响因子：
3.1
通讯作者：
Zhou JH
中科院分区：
文献类型：
--
作者：
Deng CJ;Dai FQ;Qian K;Tan QY;Wang RW;Deng B;Zhou JH
方便、准确的活检方法对肺癌的诊断极为重要。我们系统地综述了CT引导下经皮胸针活检(PTNB)、电磁导航支气管镜(ENB)、经纤维支气管镜(EBUS-TBNA)、纵隔镜和循环肿瘤细胞(CTC)等活检方法的临床最新进展和发展趋势。进行Medline和人工搜索。我们确定了相关研究，评估了研究的合格性，评估了方法学质量，总结了CT引导下PTNB(22篇引用)、eNB(31篇引用)、EBUS-TBNA(66篇引用)、纵隔镜检查(15篇引用)和CTC(19篇引用)的诊断结果和并发症。CT引导下经皮冠状动脉腔内成形术的敏感性为92.52%， ± 为3.14%，特异性为97.98% ± 3.28%。CT引导下PTNB的前两位并发症是气胸(946/4170：22.69%)和出血(138/1949：7.08%)。ENB对肺癌的检出率逐渐上升至79.79%， ± 为15.34%，以气胸为首位并发症(86/1648：5.2%)。EBUS-TBNA的检出率为86.06% ± 9.70%，前三位并发症依次为出血(53/8662：0.61%)、气胸(46/12432：0.37%)、感染(34/11250：0.30%)。纵隔镜检查的发现率逐渐上升至92.77%， ± 为3.99%，以声音嘶哑为难治性并发症(4/2137：0.19%)。聚合酶链式反应检测CTCs的敏感性和特异性分别为78.81% ± 14.72%和90.88% ± 0.53%。活检方法的选择应考虑到病变的不同部位和情况。CT引导下经皮肺穿刺活检能有效到达肺实质，但病变大小或针路长度可能会影响诊断的准确性和并发症的发生率。对于肺实质内较小、较深病变的活检，ENB法具有优势。ENB加EBUS成像可进一步提高肺实质病变的检出率。EBUS-TBNA相对安全，纵隔镜提供更多的组织采集和更好的4R和7号淋巴结的诊断率。CTC检测可考虑用于辅助诊断。
Convenient approaches for accurate biopsy are extremely important to the diagnosis of lung cancer. We aimed to systematically review the clinical updates and development trends of approaches for biopsy, i.e., CT-guided PTNB (Percutaneous Transthoracic Needle Biopsy), ENB (Electromagnetic Navigation Bronchoscopy), EBUS-TBNA (Endobroncheal Ultrasonography-Transbronchial Needle Aspiration), mediastinoscopy and CTC (Circulating Tumor Cell). Medline and manual searches were performed. We identified the relevant studies, assessed study eligibility, evaluated methodological quality, and summarized diagnostic yields and complications regarding CT-guided PTNB (22 citations), ENB(31 citations), EBUS-TBNA(66 citations), Mediastinoscopy(15 citations) and CTC (19 citations), respectively. The overall sensitivity and specificity of CT-guided PTNB were reported to be 92.52% ± 3.14% and 97.98% ± 3.28%, respectively. The top two complications of CT-guided PTNB was pneumothorax (946/4170:22.69%) and hemorrhage (138/1949:7.08%). The detection rate of lung cancer by ENB increased gradually to 79.79% ± 15.34% with pneumothorax as the top one complication (86/1648:5.2%). Detection rate of EBUS-TBNA was 86.06% ± 9.70% with the top three complications, i.e., hemorrhage (53/8662:0.61%), pneumothorax (46/12432:0.37%) and infection (34/11250:0.30%). The detection rate of mediastinoscopy gradually increased to 92.77% ± 3.99% with .hoarseness as the refractory complication (4/2137:0.19%). Sensitivity and specificity of CTCs detection by using PCR (Polymerase Chain Reaction) were reported to be 78.81% ± 14.72% and 90.88% ± 0.53%, respectively. The biopsy approaches should be chosen considering a variety of location and situation of lesions. CT-guided PTNB is effective to reach lung parenchyma, however, diagnostic accuracy and incidence of complications may be impacted by lesion size or needle path length. ENB has an advantage for biopsy of smaller and deeper lesions in lung parenchyma. ENB plus EBUS imaging can further improve the detection rate of lesion in lung parenchyma. EBUS-TBNA is relatively safer and mediastinoscopy provides more tissue acquisition and better diagnostic yield of 4R and 7th lymph node. CTC detection can be considered for adjuvant diagnosis.
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影响因子：
5.8
作者：
Asano F;Aoe M;Ohsaki Y;Okada Y;Sasada S;Sato S;Suzuki E;Semba H;Fukuoka K;Fujino S;Ohmori K
通讯作者：
Ohmori K
DOI：
10.1097/lbr.0000000000000120
发表时间：
2015-01-01
影响因子：
3.3
作者：
Bowling, Mark R.;Kohan, Matthew W.;Ben, Sharon
通讯作者：
Ben, Sharon
DOI：
10.1097/lbr.0b013e31824dd9a1
发表时间：
2012-04-01
影响因子：
3.3
作者：
Brownback, Kyle R.;Quijano, Franklin;Simpson, Steven Q.
通讯作者：
Simpson, Steven Q.
影响因子：
6.9
作者：
Chee, Alex;Stather, David R.;Tremblay, Alain
通讯作者：
Tremblay, Alain
DOI：
10.1164/rccm.200603-344oc
发表时间：
2006-11-01
影响因子：
24.7
作者：
Gildea, Thomas R.;Mazzone, Peter J.;Mehta, Atul C.
通讯作者：
Mehta, Atul C.